《稳定性冠心病患者强化降脂课件》由会员分享，可在线阅读，更多相关《稳定性冠心病患者强化降脂课件（11页珍藏版）》请在金锄头文库上搜索。
1、TNT: Treating to New Targets治疗达到新目标研究治疗达到新目标研究 稳定性冠心病患者强化降脂TNT trial : New data on intensive lipid lowering in stable CHD patients稳定性冠心病患者强化降脂稳定性冠心病患者强化降脂治疗的新数据治疗的新数据稳定性冠心病患者强化降脂TNT: Treating to New TargetsLaRosa JC et al. N Engl J Med. 2005;352.Hypothesis:Lowering LDL-C levels to wellbelow 100 mg/d
2、L could yield an incremental clinical benefitParticipants:10,001 patients with stable CHDand LDL-C 130-250 mg/dLTreatments:Atorvastatin 10 mg and 80 mgMedian follow-up: 4.9 yearsPrimary outcome:CHD death, MI, resuscitation aftercardiac arrest, fatal/nonfatal stroke稳定性冠心病患者强化降脂Benefit of intensive LD
3、L-C lowering: Accumulating evidenceLaRosa JC et al. N Engl J Med. 2005;352.030510152025StatinPlaceboHPSCARELIPIDHPSCARELIPID4S4SLDL cholesterol (mg/dL)02101901701501301109070Event(%)稳定性冠心病患者强化降脂TNT: DesignPatient populationl250 centers in 14 countries(N = 10,001)lLDL 130250 mg/dLlTG 600 mg/dLAtorvas
4、tatin 10 mgAtorvastatin 80 mg4.9 yearsAtorvastatin 10 mg8 weeksWaters DD et al. Am J Cardiol. 2004;93:154-8.稳定性冠心病患者强化降脂TNT: Baseline characteristicsLaRosa JC et al. N Engl J Med. 2005;352.Atorvastatin Atorvastatin Characteristics 10 mg (N = 5006) 80 mg (N = 4995)Age (yr)60.98.861.28.8Male sex (%)80
5、.881.2White race (%)94.194.1Systolic BP (mm Hg)1311713117Diastolic BP (mm Hg)7810 7810BMI (kg/m2)28.64.728.44.5稳定性冠心病患者强化降脂TNT: CV history of participantsLaRosa JC et al. N Engl J Med. 2005;352.% Atorvastatin % Atorvastatin 10 mg (N = 5006) 80 mg (N = 4995)Current smoker13.413.4Former smoker63.363.2
6、Systemic hypertension54.453.9Diabetes mellitus15.015.0MI57.759.0Angina81.281.8Cerebrovascular event5.35.1PAD11.412.1CHF8.17.6Arrhythmia18.518.2Coronary revascularization Angioplasty54.353.8 Bypass46.746.4稳定性冠心病患者强化降脂TNT: Baseline lipidsLaRosa JC et al. N Engl J Med. 2005;352.Atorvastatin Atorvastati
7、n Lipids (mg/dL) 10 mg (N = 5006) 80 mg (N = 4995)LDL cholesterol98189718Total cholesterol17524 17524Triglycerides15172 15172HDL cholesterol4711 4711稳定性冠心病患者强化降脂TNT: 非心源性死亡率非心源性死亡率LaRosa JC et al. N Engl J Med. 2005;352.% 阿托伐他汀阿托伐他汀 % 阿托伐他汀阿托伐他汀 10 mg 80 mg 危险比危险比 (N = 5006) (N = 4995)(95% CI)P癌症1.5
8、1.71.13 (0.83, 1.55)0.42其它非外伤原因0.91.21.35 (0.91, 2.00)0.13 稳定性冠心病患者强化降脂TNT: 对治疗的耐受性对治疗的耐受性LaRosa JC et al. N Engl J Med. 2005;352.% 阿托伐他汀阿托伐他汀 % 阿托伐他汀阿托伐他汀 10 mg 80 mg (N = 5006) (N = 4995)P不良反应事件5.88.1 0.001停药率5.37.2 3x ULN0.21.20.001 稳定性冠心病患者强化降脂TNT: 降低降低LDL-C治疗的扩展的确切益处治疗的扩展的确切益处 已超越现有指南已超越现有指南LaRosa JC et al. N Engl J Med. 2005;352.030510152025他汀安慰剂HPSCARELIPIDHPSCARELIPID4S4SLDL 胆固醇 (mg/dL)02101901701501301109070TNT (80 mg 阿托伐他汀阿托伐他汀)TNT (10 mg 阿托伐他汀阿托伐他汀)事件(%) 稳定性冠心病患者强化降脂
